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Back to Birth Control Methods.

Birth Control Pills
Continuous Use (No Period) Birth Control Pills
Depo Provera Injections
The Contraceptive Patch
The Contraceptive Ring
Emergency Contraception (Morning-After Pill)
Please read our disclaimer

The Pill – Combined Oral Contraceptives

The pill is taken each day and contains a mixture of an estrogen and a progestin. It prevents ovulation, stops implantation of an egg and changes your cervical mucus to hinder sperm transport.

How well it works:

The pill is about 95 percent effective as commonly used (missing pills, starting your pill pack late). This means for every 100 sexually active women using the pill, six to eight of them will become pregnant in the first year.

The pill can be about 99.9 percent effective if used perfectly (never late taking a pill or miss taking a pill). This means for every 100 sexually active women using the pill, less than one of them will become pregnant in the first year.

Advantages:

  • Highly effective in preventing pregnancy
  • Well-studied method
  • Can be used throughout reproductive years (no need for a break as long as you are healthy and a non-smoker)
  • Menstrual benefits including regular cycles, and a decrease in cramps and bleeding
  • Intercourse can be spontaneous
  • May help prevent ovarian and endometrial cancer, ovarian cysts, ectopic pregnancy, and benign breast disease
  • May prevent or decrease iron deficiency anemia
  • May improve acne

Disadvantages:

  • No protection against Sexually Transmitted Infections
  • Necessary to remember to take a pill every day at the same time each day
  • Common side effects include: headaches, nausea, decreased libido, depression or mood changes, vision changes, breast changes, weight changes, spotting between periods
  • Slight increase in risk for circulatory system diseases such as high blood pressure, stroke, deep vein thrombosis
  • A back-up method may be needed if you experience severe diarrhea or vomiting, if other medications/herbal remedies are taken (like antibiotics or anti-seizure medications) or if pills are missed
  • Not suggested for women over 35 who smoke 15 or more cigarettes per day

Instructions for use:

  1. Start pills at an appropriate time (at the onset or during menses, after an abortion, any time when pregnancy is excluded).
  2. Take one pill a day at the same time each day.
  3. Back-up method must be used for entire first pack of pills.
  4. Discontinue pills if experiencing severe side effects–severe abdominal pain, chest pain, severe headaches, eye problems or severe leg pain.

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CONTINUOUS USE (NO PERIOD) BIRTH CONTROL PILLS

Continuous use (no period) oral contraceptives are just like other birth control pills. They contain an estrogen and a progestin, similar to the naturally occurring female hormones. This type of birth control pill is monophasic, meaning, there is the same level of hormone in all active pills. The main difference in the extended-cycle birth control pill is that there are 84 active pills (with hormone) and 7 inactive pills (without hormone). This means you will only get your period once every 3 months.

How well it works:

Typical use of continuous use birth control pill is about 98% effective when taken every day at the same time without ever missing a pill. This means out of every 100 women using the pill for a year, 2 of them will become pregnant.

Advantages:

Only 4 periods a year, with a decrease in pain associated with your period
Very effective when used correctly
Can be used a s long as a woman wants (no break is needed)
Fertility returns soon after discontinuing the pill
May help prevent iron deficiency anemia
Can help prevent ectopic pregnancies, endometrial cancer, ovarian cancer, ovarian cysts and benign breast disease

Disadvantages:

Bleeding irregularities are the most common side effect in the first cycle, and should decrease during later cycles. One in three women will experience 20+ days of bleeding during the first cycle.

Nausea and vomiting
Breast tenderness/enlargement
Spotting between cycles
Fluid retention
Depression
Loss of sexual desire
Does not provide protection against HIV, AIDS and other Sexually Transmitted Infections

Instructions for use:

Decide which day you will start your birth control pill. You will take one pill by mouth at exactly the same time every day until the pack is empty. The last week of the pill pack is when you will get your period. You will start your next cycle of pills the day after you finished the last pill of the previous pack. Be sure to always start your next pack of pills on time even if you are still bleeding. It is important to not skip pills; this will make the birth control pill less effective and may cause out of cycle bleeding.

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DEPO PROVERA

Depo Provera is a progestin only injection given every 12 weeks that prevents ovulation, inhibits implantation of an egg and changes cervical mucus to hinder sperm movement.

How well it works:

Depo-Provera is about 99.7 percent effective when injections are regularly spaced 12 weeks apart. This means for every 100 sexually active women using Depo, less than one of them will become pregnant in the first year.

Advantages:

  • Only need injection every 12 weeks
  • No pills to take each day
  • Nothing to insert before intercourse
  • Intercourse can be spontaneous
  • Decrease in menstrual bleeding and cramping
  • Decrease risk of ovarian cancer, endometrial cancer, uterine fibroids and ectopic pregnancy
  • No estrogen, so less likely to contribute to cardiovascular complications
  • Safe for breast feeding women

Disadvantages:

  • No protection against Sexually Transmitted Infections
  • Common side effects include: headaches, menstrual changes, depression or mood changes, weight changes, breast tenderness
  • If you wish to discontinue use because of side effects, it will take 12 weeks for your body to be free of the Depo Provera and there is no way to "reverse" the side effects during that time
  • Decrease in the "good" kind of cholesterol, HDL, high density lipoprotein levels
  • Delayed return of fertility if wanting to conceive soon after discontinuing Depo

Instructions for use:

  1. Rule-out existing pregnancy
  2. Return to provider every 12 weeks for repeat injections
  3. Back-up method needed for the first two weeks after the initial injection

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The Contraceptive Patch

The patch is a combined hormonal contraceptive worn on the lower abdomen, buttock, upper outer arm or upper torso (EXCLUDING THE BREAST). The patch is changed once a week for three weeks and the fourth week is patch-free. The patch prevents ovulation, thickens and reduces the volume of cervical mucus (which decreases sperm penetration) and thins the endometrium (which may reduce the likelihood of implantation).

How well it works:

The patch is 99 percent effective with perfect use (always changing the patch on time and following all instructions). This means for every 100 sexually active women using the contraceptive patch, one of them will become pregnant in the first year. However, studies have shown that it may be less effective in women weighing 198 lbs or more.

When should patch use begin?

  • Within five days of the start of a regular menstrual period
  • Within five days of a complete abortion or miscarriage occurring before 13 weeks
  • At least four weeks after a complete abortion or miscarriage greater than 13 weeks
  • At least four weeks after giving birth if not breast feeding
  • On the first day of menstruation on a different hormonal contraception

A back-up method of contraception should be used for seven days after beginning the patch. This first day the patch is applied is the "patch change day."

Where should the patch be applied?

The patch can be applied to any one of four sites: the lower abdomen, buttock, upper outer arm or upper torso (EXCLUDING THE BREAST). The patch should never be applied to irritated or broken skin. The use of make-up, creams, lotions, powders or other topical products should not be used in the area where the patch is applied.

How is the patch applied?

The patch should be carefully removed from the foil pouch, as to not remove the clear liner at the same time. One half of the clear protective layer should be peeled at a time. It is important to not touch the sticky surface. Apply the first sticky half of the patch to the skin before removing the other half of the protective layer. Once the patch is applied, firmly press on it for ten seconds to be sure the edges stick. It is recommended that the patch be checked daily for adhesion.

The patch is applied on day one (the patch change day) and worn continuously for seven days (week one). On day eight (the patch change day), the used patch is removed and discarded, and a new patch is immediately applied, but not in the same exact spot to avoid irritation.

A new patch is applied on week two and week three. A patch should not be worn on week four. This is the patch-free week and menstruation should begin. The next four-week cycle begins on the normal patch change day, regardless of when menstruating began or ended.

What happens when the patch is partially or completely detached?

  • For less than one day (up to 24 hours): Try to reapply to the same place or replace the patch (no back-up contraception needed, patch change day remains the same).
  • For more than one day (more than 24 hours): A new cycle should be started by applying a new patch immediately (back-up contraception needed for seven days and there is a new day one and patch change day). May not be protected from pregnancy.

What happens if the patch has not been changed?

  • At the start of a new cycle: Apply a new patch immediately (back-up contraception needed for seven days and the patch change day is different).
  • In the middle of the patch cycle: If it has been one or two days apply a new patch (no back-up contraception needed, patch change day remains the same). If it has been two or more days stop current cycle and begin a new four week cycle with a new patch (back-up contraception needed for seven days and there is a new day one and patch change day). May not be protected from pregnancy.
  • At the end of the patch cycle: Remove the patch and begin the next cycle on the usual patch change day (no back-up contraception needed).

Disadvantages:

Possible side effects include: application-site reactions, nausea and vomiting, breast tenderness and/or enlargement, headache and menstrual cramps and abdominal pain

(Other side effects may include: change in appetite, nervousness, depression, dizziness, loss of scalp hair, rash and vaginal infections)

Can other medications make the patch less effective?

Some medications can make the patch less effective. It is important to always tell your provider that you are on the patch. Back-up contraception should be used while taking other medications.

Please notify Aradia Women's Health Center or, in the case of a life threatening emergency, call 911 if any of the following symptoms occur:

  • Sharp chest pain, coughing of blood or sudden shortness of breath
  • Pain and/or swelling in one calf
  • Crushing chest pain or heaviness in the chest
  • Sudden severe headache or vomiting, dizziness or fainting, disturbances of vision or speech, weakness, or numbness in an arm or leg
  • Sudden partial or complete loss of vision
  • Breast lumps
  • Severe pain or tenderness in the abdominal area
  • Difficulty sleeping, weakness, lack of energy, fatigue or change in mood
  • Jaundice or yellowing of the skin or eyeballs, accompanied by fever, fatigue, loss of appetite, dark colored urine or light bowel movements

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The Contraceptive Ring

The ring is a combined hormonal contraceptive ring that is inserted into the vagina. The ring is removed from the vagina after three weeks of continuous use. The fourth week is a ring-free week. The ring prevents ovulation, thickens and reduces the volume of cervical mucus (which decreases sperm penetration), and thins the endometrium (which may reduce the likelihood of implantation).

How well it works:

The ring is highly effective: between 98 percent and 99 percent effective with perfect use. This means for every 100 sexually active women using the contraceptive ring, one to two of them will become pregnant in the first year.

When should ring use begin?

  • Within five days of the start of a regular menstrual period
  • Within five days of a complete abortion or miscarriage occurring before the 13th week
  • Not before four weeks of a complete abortion or miscarriage greater than 13 weeks
  • At least four weeks after giving birth to a baby if not breastfeeding
  • When switching from combined hormonal birth control pills, anytime during the placebo pill week
  • When switching from an injectable form of birth control, on the day the injection is due
  • Immediately upon the removal of an IUD

A back-up method of contraception should be used until the ring has been in place for seven continuous days.

How is the ring inserted/removed?

You should wash your hands before handling the ring. Choose a position that is comfortable for you (sitting, squatting, lying down or standing with one leg up). Holding the ring between the thumb and index finger, the opposite sides can be pressed together. Next, gently push the folded ring into the vagina. The exact placement within the vagina is not important for it to work correctly. You may or may not feel the ring at this time. If you do, you can try to gently push the ring further into the vagina. After three weeks of continuous placement, the ring can easily be removed.

The ring can be removed by hooking the index finger under the forward rim or by holding the rim between the index and middle finger and pulling it out. This should be done on the same day of the week and approximately the same time of day as when it was inserted. The fourth week is a ring-free interval. Women typically begin to bleed about two to three days after removal of the ring. The next four week cycle begins on the same day and time of the week that it was originally inserted and removed on, regardless of when menstruating begins or ends.

What happens if the ring is accidentally expelled?

  • For less than three hours: The ring may be reinserted after rinsing it in cool to lukewarm (NOT HOT) water.
  • For more than three hours: The ring may be reinserted after rinsing it in cool to lukewarm (NOT HOT) water. However, you will not be protected from pregnancy. Please use a back-up method of contraception until the ring has been in place for seven continuous days.

What happens if the ring wasn't removed or reinserted?

  • If the ring has been in place for greater than three weeks, but less than four weeks: Remove the ring immediately and give yourself a ring-free week and then insert a new ring.
  • If the ring has been in place for more than four weeks: The ring should be removed and a new ring can be inserted, as long as the chance of pregnancy has been ruled out. Please use a back-up form of contraception until the ring has been in place for seven continuous days.
  • The ring-free interval has been greater than one week: A new ring can be inserted, provided the chance of pregnancy has been ruled out. Please use a back-up form of contraception until the ring has been in place for seven continuous days.

Disadvantages:

Possible side effects include: increased vaginal infections, nausea and vomiting, breast tenderness and/or enlargement and out of cycle uterine bleeding.

(Other side effects may include: weight gain, headaches, fluid retention, menstrual cramps/abdominal pain and depression)

Can other medications/herbal remedies make the ring less effective?

Some medications and herbal remedies can make the ring less effective. It is important to always tell your provider that you are using the ring. Back-up contraception should be used while taking other medications and some herbal remedies.

Studies have shown that a single dose of spermicide and vaginal yeast medications did not change the efficacy of the ring. However, long-term use was not studied.

Please notify Aradia Women's Health Center or, in the case of a life threatening emergency, call 911 if any of the following symptoms occur:

  • Sharp chest pain, coughing of blood or sudden shortness of breath
  • Pain and/or swelling in one calf
  • Crushing chest pain or heaviness in the chest
  • Sudden severe headache or vomiting, dizziness or fainting, disturbances of vision or speech, weakness, or numbness in an arm or leg
  • Sudden partial or complete loss of vision
  • Breast lumps
  • Severe pain or tenderness in the abdominal area
  • Difficulty sleeping, weakness, lack of energy, fatigue or change in mood
  • Jaundice or yellowing of the skin or eyeballs, accompanied by fever, fatigue, loss of appetite, dark colored urine, or light bowel movements

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EMERGENCY CONTRACEPTION (MORNING-AFTER PILL)

Emergency Contraception is a safe and effective birth control method used to prevent pregnancy after unprotected sex or birth control failure. Two large doses of either combined oral contraceptives or progestin only contraceptives (Plan B) are taken, causing delayed ovulation and possibly altering the transport of the sperm or ova.

Emergency Contraception is just that – a birth control method for when all else fails. It prevents a pregnancy from starting. This is not the same thing as Mifepristone (RU-486 or the abortion pill). EC helps to prevent pregnancy and doesn't work if a woman is already pregnant.

In Washington state, women can purchase Emergency Contraception from most local pharmacies without a prescription. Talk to your pharmacist, doctor, health care provider or local clinic about getting a dose of Emergency Contraception to keep in your medicine cabinet – just in case. Studies show that women are more likely to use Emergency Contraception if they have it readily available.

Women can also purchase Emergency Contraception on-line, or call 1-888-Not-2 Late to find out where EC providers are located in your area. For more information on Emergency Contraception read this fact sheet: www.backupyourbirthcontrol.org/toolkit/print/ec-factsheet.htm.

Examples of when EC can be used:

  • After unprotected or unplanned sex
  • When the condom broke or slipped off
  • When your male partner did not withdraw before ejaculating or you're not sure if he did
  • There was an error using your hormonal birth control (i.e. you missed your pill, your patch feel off, you missed your Depo injection, etc)
  • Your diaphragm or cervical cap was not placed securely

How well it works:

When taken within 72 hours of sexual intercourse, combined hormonal EC is approximately 75-80 percent effective and progestin only EC is approximately 89 percent effective. EC can be taken up to five days after sex but the effectiveness is greatly reduced.

Advantages:

  • Opportunity to prevent pregnancy after intercourse
  • Safe for almost every woman
  • Safe to take several times
  • No known increased risk of birth defects if the woman is already pregnant
  • Progestin-only EC can be used when breast feeding

Disadvantages:

  • No protection against Sexually Transmitted Infections
  • Possible minor changes in next menstrual period (it may be early or late and the flow may be different)
  • Possible side effects include: nausea, vomiting, fatigue, headache, abdominal pain and dizziness; less side effects with progestin only forms of emergency contraception

Instructions for use:

  1. Take the first dose of pills within 72 hours after unprotected intercourse. Again, EC can be taken up to five days after unprotected intercourse, but the success rate in preventing pregnancy is greatly reduced.
  2. Take the second dose 12 hours after the first dose.
  3. Take Dramamine to help prevent nausea.
  4. Get a pregnancy test if you don't have your period three weeks after taking EC.

Aradia Women's Health Center is a co-sponsor of the Back Up Your Birth Control campaign to inform and educate the public about EC.

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